Course Information

Educational Need

Hospitalized patients admitted to cardiac and critical care units commonly present with QT-interval prolongation. These patients are frequently administered QT-interval prolonging drugs, placing them at increased risk for syncope and sudden cardiac death. Prolonged QT-interval is a risk factor for a life threatening form of ventricular tachycardia, Torsades de Pointes. The American Heart Association (AHA) recommends that hospitalized patients receiving QT-prolonging drugs as well as those with bradycardia, K and MG electrolyte disturbances, or drug overdose should receive QT-interval monitoring. As many as 70% of critically ill patients will have conditions for which the AHA recommends monitoring and as many as one third of these patients will develop QT-interval prolongation requiring management. Unfortunately, studies indicate that QT-interval monitoring is underutilized in the hospital setting. In fact, a recent multi-site randomized clinical trial found that only 21% of hospitalized patients with an indication for QT-interval monitoring were actually monitored. The authors of the study suggest that underutilization of QT-interval monitoring may be due in part to nurses’ lack of knowledge regarding the significance of QT-interval prolongation and how to correct for heart rate when determining the QT-interval.

An educational need has been identified for a continuing education activity on ECG QT-interval monitoring for the identification of QT-interval prolongation.

Overview

Hospitalized patients admitted to cardiac and critical care units commonly present with QT-interval prolongation. These patients are frequently administered QT-interval prolonging drugs, placing them at increased risk for syncope and sudden cardiac death. The American Heart Association (AHA) recommends that hospitalized patients receiving QT-prolonging drugs as well as those with bradycardia, K and MG electrolyte disturbances, or drug overdose should receive QT-interval monitoring. Unfortunately, studies indicate that QT-interval monitoring is underutilized in the hospital setting. This activity will review the scope and impact of QT-interval prolongation and will discuss QT-interval monitoring.

Learning Outcome / Objectives

After completing this continuing education activity, nurses and telemetry technicians will be able to monitor patients for QT-interval length changes and use this information to identify QT-interval prolongation and Torsades de Pointes. Specifically, they will be able to measure the QT-interval, identify QT-interval deviations, and predict the occurrence of dysrhythmia based on QT-interval evaluation.

Outline

• Prolonged QT-Interval and Torsades de Pointes
  • Significance and impact on patient outcome
  • Pathophysiology
  • Epidemiology
  • Drugs causing QT-interval prolongation
  • Risk factors and exacerbating conditions
  • Prevalence of QT-interval prolongation in the hospitalized patient
• QT-Interval Monitoring
  • Identifying patients requiring monitoring
  • Performing QT-interval monitoring (including correction formula)
  • ECG features and signs of impending arrhythmia
  • Confounders of accurate monitoring
• Acute management of QT-interval prolongation
• Patient education
• Case Examples